MEDICARE: DR. ASMA SIDDIQUI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	25MA07807000	NJ
2	208100000X	Physical Medicine & Rehabilitation Physician	ME150085	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639187503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASMA SIDDIQUI MD

Provider Business Mailing Address
First Line	:	1865 VETERANS PARK DR STE 101
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0447
Country	:	US
Telephone Number	:	239-254-7778
Fax Number	:	855-959-1692

Provider Business Practice Location Address
First Line	:	7117 CONGDON ROAD
Second Line	:	200
City	:	FORT MYERS
State	:	FL
Zip	:	33908
Country	:	US
Telephone Number	:	239-254-7778
Fax Number	:	855-959-1692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/08/2022

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